Evaluation of uterine bleeding after an endometrial ablation

OBJECTIVE: To determine the feasibility of evaluation of abnormal uterine bleeding after endometrial ablation with hysteroscopy, transvaginal ultrasonography (TVUS), and endometrial biopsy (EMB). STUDY DESIGN: Retrospective cohort. RESULTS: From 2000– 2015, chart review identified 206 women with abnormal bleeding post-ablation, of which 53 (25.7%) opted for a hysterectomy with no further evaluation. Of the remaining 153 (74.3%), evaluation post–endometrial ablation was performed by EMB (n=76), TVUS (n= 106), sonohysterogram (n=15), and/or hysteroscopy (n=66). Successful EMB (defined by presence of endometrium) post-ablation occurred in 64 patients (84.2%). Hysteroscopy was successful (defined by visualization of the uterine cavity and a sounding length of ≥4 cm) in 93.9% of patients; bilateral tubal ostia were seen in 27.3%. Successful sonohysterography (defined by the ability to distend the cavity, identify fluid pockets, and visualize the endometrial stripe) was accomplished in 26.7%. TVUS resulted in the presence of a visualized endometrial stripe in 75.5% of patients. In those who underwent hysterectomy, post-ablation EMB and TVUS were consistent with histology and gross pathology. All of the patients (n=2) with endometrial neoplasia (1 atypical hyperplasia and 1 adenocarcinoma) were iden-tified by post-ablation EMB. CONCLUSION: For women who present with bleeding post-ablation, EMB, hysteroscopy, and TVUS are valuable tools to rule out malignancy and intracavitary pathology. (J Reprod Med 2020;65:157–163).